Medicare Throws Out “Improvement Standard”

skilled_maintenanceA recent change in Medicare’s skilled maintenance policy marks a big step forward for beneficiaries who need therapeutic care (physical, occupational, or speech therapy) to maintain their current condition or prevent decline of health. After the January 24th settlement of the Medicare Improvement Standard case Jimmo v. Sebelius, Medicare is required to cover “skilled maintenance care” to maintain a patient’s current health status and prevent further deterioration of the patient’s functional abilities.

 

This is great news for seniors and disabled individuals who need skilled care. Before last month’s court settlement, a patient’s qualification for therapy or other skilled care hinged on the Medicare Improvement Standard. Medicare’s policy was that a beneficiary’s skilled care services would only be covered if those services were likely to improve the patient’s condition. That is to say that once the patient had “plateaued,” Medicare would refuse to cover therapy and other skilled care.

The downside of this coverage policy was that it disregarded the value of skilled care in maintaining a patient’s current condition and preventing further deterioration. In many cases, even though full recovery may not be possible, skilled maintenance services can prevent or delay the decline of an individual’s condition, which in turn may reduce the long-term cost of care while improving the quality of life. And the monetary savings don’t just help the patient and his or her family: by avoiding the expense of covering repeated hospitalizations and other costly long-term care needs, Medicare may well see its overall expenditures shrink.

The Jimmo settlement marks a major policy change for Medicare, and it goes into effect immediately. That means that if you or your loved one are denied skilled maintenance care based on the Improvement Standard, you should inquire about coverage under Medicare’s new policy.

For more information about this and other Medicare policies, get in touch with us at Elder Law of East Tennessee. We’ll be happy to answer your questions and point you in the right direction.